The Quality Efficiency Monitoring System (QUEMS) has enabled the Department of Emergency Medicine to provide some solutions to the multifaceted problems involved in evaluation of patient care. Evaluation was performed on a longitudinal basis (observation of a single patient from time of arrival to time left DEM). Actual observation of care was conducted by trained observers (process). Analysis of DEM patient was carried out by a modified problem oriented record review system. Finally the outcome was noted and correlated with physiological progression and socioeconomic inpact. 450 cases have been observed during the QUEMS Project. 56 Illness/Injury categories were specifically selected. This prelminary system requires continuous refinement and expansion in order to provide a Quality Assurance System (QAS). Out of the ten project objectives the following are enumerated: (a) Develop a model for QAS in Emergency Medicine adaptable to a large hospital. (b) Develop standards for 56 different illness/injuries. (c) Refine and implement evaluative measures of patient processing, resource allocation and patient outcomes. (d) Design method for evaluating and upgrading patient records. (e) Determine variable relationships between process, resource allocation and outcome and examine potential relative risk factors. (f) Provide a working model of research methodology which is suitable for evaluating quality of patient care in Emergency Medicine. (g) Design models for further primary/emergency care studies on process, resource allocation or outcome. (h) Educational evaluation material will be developed on an on-going basis. (i) An application of the up-dated QAS will be conducted first in the DEM, and after refinement will be tested in two community hospitals with different staffing patterns and patient management systems from that of the DEM. A final application of QAS will be made at the DEM and a final report will be submitted on the above program.